ILAE Registration 2009

To register please complete all the fields on this page and submit using the button below

Are you currently a member of the UK Chapter of ILAE?
As an existing member of ILAE you may register for no additional charge

Yes No

If you are not a current member, you have two payment options:

Option A: Join the ILAE for one-year including meeting registration for £25.00
Option B: A one-off meeting registration fee of £30.00 (You will be invoiced for this amount after registration)

If you select Option A, you must submit your details to the ILAE today by completing the following form

Pressing this button will launch a new browser window, please return to this page to complete the registration process

Kindly note that places are limited and will therefore be issued on a first come, first served basis.

Title:
First Name:
Surname:
Job Title
Speciality
Department
Hospital
Hospital Address
Contact Telephone Number
Contact e-mail Address (Please note that all correspondence will be sent to this email address unless you state otherwise)

Please tick all relevent boxes

Yes, I would like to attend

I require dinner on Friday, 18^th Sept

I require accommodation on Friday, 18^th Sept

I require accommodation on Sat, 19^th Sept

I require lunch on Sun, 20^th Sept

I have the following special dietary requirements:

I have the following Allergies

Any other comments (e.g. Late arrival, etc.)
Emergency Contact Information

Please confirm all information is correct before pressing "Register"